Healthcare Provider Details

I. General information

NPI: 1649012469
Provider Name (Legal Business Name): ABIGAIL ORTEGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LOCUST ST STE C
OLD MONROE MO
63369-1005
US

IV. Provider business mailing address

PO BOX 85
OLD MONROE MO
63369-0085
US

V. Phone/Fax

Practice location:
  • Phone: 636-336-2346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2021050549
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2021050549
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: